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Clan Graham Society Please print the following and mail to: Bill Graham1275 Castle Hill Cres Ottawa ON, Canada K2C 2B2
613 225 4453
E-mail – bill.graham@rogers.com Canadian Membership Application Please print legibly
Name: First _______________ Middle ________________ Last __________________________ Spouse: First ______________ Middle ________________ Last __________________________ Wife’s Maiden Name: ___________________________________________________________________ Street Address: ________________________________________________________________________ City: ____________________ Prov. ______________ Postal Code: ___________________ Country: ________________ E-mail Address: ____________________________________ Tel. (___)____________________ Please print clearlyI prefer my name to be listed On the membership card as: _____________________________________________________________ Spouse: _____________________________________________________________ Membership is only $25 CDN a year for Regular and Regular and Spouse. Associate memberships are available at $25CDN to persons with a genuine interest in the objectives and principals of Clan Graham Society and who do not have Graham lineage. If you can, and wish to receive the Clan Graham Newsletter by E-mail, membership will be $20. Please provide the necessary e-mail information above. You will need to advise the membership Chairperson of any changes to this address which might occur in the future, so that you do not miss receiving the CGS Newsletter by e-mail. Life memberships are also available. Make all cheques payable to Clan Graham Society. Thank you. Membership type: Regular ____ Regular & Spouse ____ Associate ____ Associate & Spouse ____ Payment Type: Cash _____ Cheque _____ Amount (please circle) $25 or $20 e-mailRegional Commissioner / Convener / Games Chairperson _______________________Region: ___________ Referral: Games Tent ______ Internet _____ Publication Ad. _______ Membership # _______________ ( Assigned by Membership VP)March, 2009 Form to be completed by Convener / Games Chairperson |
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